Speaking truth to power has its price in the Trump administration. The former Eli Lilly executive was shouted down by White House aides as “alarmist” and sidelined by Jared Kushner, Mike Pence and others willing to give the president a more rosy view. And on Sunday night, Trump lashed out at Azar by name for the first time, following a New York Times report that Azar had “directly warned Mr. Trump of the possibility of a pandemic during a call on Jan. 30, the second warning he delivered to the president about the virus in two weeks.”

After complaining about “mayhem” at the White House, Azar's future is uncertain but his attempts to get top officials and President Trump to pay attention to the coming pandemic should not be lost in the fog of war as Trump recasts history in his favor.

Almost every Democrat voted against Azar’s confirmation as health secretary in January 2018. As the president of the U.S. division of Eli Lilly, he had approved the tripling of the price of insulin and spoken out against the Affordable Care Act, insisting the free market should handle health care.

Democrats assumed he would be a shill for the pharmaceutical industry, but a Senate Democratic aide told the Daily Beast those early expectations that Azar would be an “ideological hack” proved wrong: “He’s an adult in the room. He’s not showy. He’s a total nerd, incredibly academic in the way he thinks through these things.” Another Democratic aide said, “Within our world, he’s one of the few good actors.”

As the Washington Postreported in its deep dive into the administration’s response during the first 70 days of the coronavirus pandemic (which this column draws heavily from), Azar first learned from the director of the CDC, Robert Redfield, in a phone call on or about Jan. 1 that an unknown respiratory illness was sickening people in Wuhan.

Azar had his chief of staff notify the National Security Council and by Jan. 7 had begun convening a task force that included Redfield and Dr. Anthony Fauci, the now famous infectious disease scientist from the NIH. By mid-January, they had begun drafting contingency plans to enforce the Defense Production Act.

Nobody had yet briefed President Trump on what was looking more and more like a pandemic. That was left to Azar, who phoned the president at Mar-a-Lago on Saturday, Jan. 18. According to multiple media reports, before Azar could even bring up the virus, Trump was berating him for failing to follow through on a full ban of all vaping flavored products, a subject Trump follows closely.

Azar has an uneasy relationship with Trump, who regards him as “alarmist.” Stylistically, they couldn’t be more different, and Trump doesn’t like bearers of bad news. “He’s happy to suck up to the president once in a while, but he’s not going to change data or tell lies for anybody,” says a source who worked with Azar in the pharmaceutical industry. “He’s a highly ethical person.”

Azar is familiar with global health threats, having served at HHS during the outbreak of bird flu in 2005. This time, he immediately began to sound the alarm bells for a nationwide surveillance system. But that would require a diagnostic test that did not yet exist, and it would cost money the Trump White House didn’t want to spend.

In late January, an agitated Azar called National Security Adviser Robert O’Brien, who was out of the country with Trump at Davos. Azar told O’Brien it was “mayhem” at the White House with no one in charge and aides demanding multiple duplicative briefings.

At Davos on Jan. 22, Trump got his first question on the coronavirus. Was he worried? “No. Not at all,” he said. “We have it totally under control… It’s one person coming in from China… It’s going to be fine.”

In late January and early February, Azar argued for a multibillion dollar supplemental budget request, but White House aides rejected it as too high, and worried it would look alarmist. On Feb. 4, while Trump was delivering his State of the Union address in the House chamber, Azar called Russell Vought, the acting director of the OMB, who told him to submit a proposal, which he did the next day for more than $4 billion.

Aides didn’t like Azar going around them, and there was a shouting match in the Situation Room in the White House. As a former top pharmaceutical executive, Azar already had the reputation of being a prickly boss. He held his ground and defended his request, which the OMB cut almost in half to $2.5 billion. Days later, Congress voted $8 billion to boost the public health response, which should have vindicated Azar but only intensified the animosity toward him in the White House.

Azar made some bad bets. He relied on assurances from the CDC’s Redfield about a workable test, which didn’t materialize. It wasn’t until Feb. 29 that the FDA lifted bureaucratic regulations to allow commercial labs to proceed with testing. Valuable time was lost.

And for whatever reason, Azar didn’t get through to Trump.

From the time of their first phone call on Jan. 18, when Azar told him about the virus, Trump held eight rallies with thousands of people assembled, and played golf six times.

Azar ran the administration’s response until Trump tapped Pence on Feb. 26. Azar has been sidelined ever since, with his agency disempowered in decision-making and his performance pilloried by a range of White House officials.

Aides who report to the president’s son-in-law have commandeered space on the seventh floor of the HHS building, and CMS administrator Seema Verma, whose agency reports to Azar, has taken his place at the White House coronavirus task force briefings. Trump likes her, and she’s one of Pence’s people from Indiana, connections that Azar can’t match in a White House that runs on personality and loyalty.

For now, Azar is keeping his head down and trying to coordinate the push to find a vaccine. He believes the pharmaceutical industry is best positioned to deliver that vaccine, and the race is on. People who know him say he believes in his mission even if the president doesn’t believe in him.